With American soldiers serving at the military hospital in Landstuhl on the differences between the work of a medic and a paramedic, and on the specific character of work on missions, talks Michał Zieliński.

What are the competences of the US Army medics?

Katherine Miller: Each sixty-eight whiskey [military code for combat medics], i.e. a medic or a paramedic, usually works under the supervision of a physician or a physician assistant [a function that does not exist in the Polish medical system]. It means that our capabilities are conditional not only on our own qualifications, but also the type of license possessed by the supervising person. The rest depends on where we operate. Our responsibilities include basic activities, like resuscitation, but also much more advanced medical procedures, for example chest drainage. However, we more often perform such procedures on missions than in our everyday work.

What is the difference between a medic and a paramedic in the US Army?

Richard Aguilar: The main difference is that paramedics can work without a supervisor, so they are more independent. This is my case – as a flight paramedic [68WF3] serving on board a MEDEVAC helicopter, I am the person who decides what medical procedures to implement. It can be mechanical ventilation, chest drainage, or ACLS [advanced cardiac life support]. We can also administer drugs, such as opiates. It needs to be kept in mind, though, that all flight paramedics are always bound by the standard medical operating guideline [SMOG]. We have to adjust our actions to these rules.
Thurman L. Reynolds: I want to mention one more important thing. In order to obtain basic combat medic qualifications, you need to complete a 16-week-long course. A paramedic has to attend a whole series of trainings which last almost a year. Skills and experience gained in these two cases differ significantly.

Are flight paramedics also prepared to serve on the ground?

Richard Aguilar: As soldiers of an air company, we can be appointed to work at a hospital or another unit on the ground – currently, for instance, we are working at a hospital in Germany. It is a bit different during a mission. If the situation on the ground requires our support, we will obviously provide it, but when we are on duty, we always have to be ready to jump into our helicopter and go on an operation. This is our main task.

You are now deployed in Germany. Are your everyday duties different from what you normally do at home?

Thurman L. Reynolds: Our duties at the military hospital in Landstuhl are comparable to what we would be doing in the USA. We also have similar competences. The difference is that the outpost in Germany is the biggest hospital of this type in Europe. We are the only ones in this part of the world who provide level four medical support, which includes specialist surgical procedures, rehabilitation and convalescence.

Is your service limited to the army or do you also gain experience in civilian institutions?

Thurman L. Reynolds: Combat medics and paramedics often work in hospital emergency rooms or in ambulances after they finish service. I have also seen our soldiers working as certified nurse assistants on various wards of American hospitals. In such circumstances, they have limited powers, as there is no military physician whose license would enable them to work in the full extent. However, a lot depends on the state where they serve. Each of the 50 US states has its local laws and a different range of duties prescribed for medics.

Do the hours spent in civilian hospitals later prove useful in the army?

Katherine Miller: Even if a military medic is not authorized to perform a certain action in a civilian hospital, they still deal with real-life situations and cases. They get used to them, but also observe the work of other paramedics and doctors. It is a very valuable lesson.

Does it ever happen that combat medics expand their competences due to gaining such experience and become paramedics?

Richard Aguilar: Usually, we start service in the army as combat medics. After getting some experience and completing various courses, we can apply to join the air company. If the application is accepted, we are directed to Fort Sam Houston in San Antonio, with the US Army’s main school for paramedics. After having finished the school, which takes about half a year, you need to undergo intensive care training. This takes another eight weeks. Then you get a FOX 2 [Flight Paramedic] certificate and you are directed to an air unit. This in fact is the actual start of a long path, along which you acquire skills and experience as a member of a helicopter crew.

How can you climb up the professional ladder from there?

Katherine Miller: The US Army provides soldiers with educational opportunities at various levels. Sixty-eight whiskey can develop as medics and paramedics, but also start studies and become nurses, physician assistants, or even physicians. There are programs which enable soldiers to develop their career along such a path, but it is a very long and laborious process. First you need to acquire skills that qualify you to begin medical studies. After graduating, you must complete internship, residency, specialization, and practice. Even if you are a paramedic and you already have some medical knowledge, the whole process will still take over 10 years. Only after this time do you become a physician who can work independently. The army covers all costs, but later you have to stay in service for a required period of time.

What is the most difficult part of working as a US Army medic and paramedic?

Katherine Miller: One of the hardest things I had to face was a mass casualty incident on one of my missions. Basically, there were more and more victims with every passing minute, and it was impossible to evacuate them. We had to decide which patients needed immediate help, and which of them we wouldn’t be able to save. We couldn’t take the wounded for detailed examinations, where a physician would determine their state and their chance of survival. We had to base our decisions on what we saw. I think that such situations are the hardest, no matter what army you serve in. Even more so when you are trying to save your fellows. In such cases you must put aside all your emotions to make decisions.

Command Sergeant Major Thurman L. Reynolds serves at the US military hospital in Landstuhl. He started his service in the US Army as a combat medic. He has been on many foreign missions, i.a. in Bosnia and Afghanistan.

Combat medics often work in hospital emergency rooms after finishing service

Sergeant First Class Katherine Miller is the head of the family medicine ward at the American military hospital in Landstuhl. She has participated in many combat missions, i.a. within the frame of operation Enduring Freedom (Task Force Defender) and Iraqi Freedom (Task Force North).

When you are trying to save your fellows, you must put aside all your emotions to make decisions

Staff Sergeant Richard Aguilar is a flight paramedic (68WF3) of the 2nd Battalion of the US Army’s 1st Air Regiment.

Paramedics can work without a supervisor, so they are more independent. As a flight paramedic on duty, I am the one who decides what medical procedures to implement